Introduction: The clinical and public health implications of the convergence of the human immunodeficiency virus (HIV) epidemic and chronic viral hepatitis in sub-Saharan Africa are poorly understood. This study was designed to determine the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV), and the impact of co-infection on baseline serum alanine transaminase (ALT), CD4+ T lymphocyte (CD4) count, and plasma HIV-RNA (viral load) in a cohort of HIV-infected Nigerians. Methods: A retrospective study was conducted, on eligible treatment-naive patients who presented between August 2004 and February 2007 to the University College Hospital (UCH), Ibadan, Nigeria. Demographic data and pre-treatment laboratory results (hepatitis B surface antigen (HBsAg), HCV antibodies (anti-HCV), ALT, CD4 count and viral load) were retrieved from the medical records. Fisher's exact, two sample t-tests, and the Wilcoxon rank sum tests were used to compare groups. A logistic regression model was fitted to explore characteristics associated with co-infection status. Results: A total of 1779 HIV-infected patients (male: female ratio, 1:2) met inclusion criteria. HBsAg was present in 11.9%, anti-HCV in 4.8% and both markers in 1%. HBsAg was more common among males than females (15.4% vs 10.1%, respectively p = 0.001) while anti-HCV was detected in a similar proportion of males and females (5.3% versus 4.6%, respectively p = 0.559). HIV-infected patients with anti-HCV alone had a lower mean baseline CD4 count compared to those without anti-HCV or HBsAg (197 cells/mm3vs247 cells/mm3, respectively p = 0.008). Serum ALT was higher among patients with HBsAg compared to those without HBsAg or anti-HCV (43 International Units (IU) vs. 39 IU, respectively p = 0.015). Male gender was associated with HBV co-infection on logistic regression (OR1.786; 95% CI, 1.306-2.443; p < 0.005). Conclusion: More HIV-infected females than males presented for care in this cohort. We identified a relatively high prevalence of HBV and HCV co-infection in general, and a higher rate of HBV co-infection among males than females. Pre-treatment CD4 count was significantly lower among those with HCV co-infection, while ALT was slightly higher among those with HBV co-infection. Triple infection with HIV, HBV and HCV was present in a small but significant proportion of patients. These findings underscore the importance of testing for HBV and HCV in all HIV-infected persons in our setting.
Background and Objectives: The aim of this study was to establish which motivational, deterrent and socio-demographic factors that would engender long-term commitment to voluntary, non-remunerated blood donation. Study Design and Methods: A cross-sectional sample survey of blood donors who participated in the 2021 world blood donor day in Ibadan, Nigeria, was conducted. Donors filled in a self-administered questionnaire during donation. Data on motivation and deterrent were analyzed using factor analysis. Results: The majority of the blood donors were aged 21-40 years and they had donated 0-53 times in the past. Three-quarters had donated at least 10 times previously. Two dimensions of blood-donor motivation were identified with factor analysis. These were: self-esteem and social reasons (such as the influence of friends and family). The most important deterrent factors for blood donation were ‘hate sight of blood” and time taken to donate. Conclusion: The motivation factors for being a VNRD are related to self-esteem and social factors. We recommend that these factors should be the backbone of campaigns and awareness programme in effort to increase and retain VNRD pool our environment.
The objective of this review is to assess the effectiveness of intravenous calcium given during exchange blood transfusion (EBT) in neonates.More specifically, the objectives of the review are to determine whether:Neonatal hyperbilirubinaemia is an abnormally high level of bilirubin in the circulating blood, resulting in clinically visible icterus or jaundice. A serum bilirubin level above 5 mg per dL (86 μmol per L) is a frequently encountered problem worldwide and is a common reason for neonates to present to the emergency department.Unconjugated bilirubin is toxic to infants' brains when the concentration exceeds a certain level. An unconjugated serum bilirubin concentration at toxicity level is described as 'severe hyperbilirubinaemia'. The concentrations that define toxic level vary, depending on the gestational age of the neonates and fetal maturity.Severe hyperbilirubinaemia can cause encephalopathy if not promptly treated, with significant complications such as athetoid cerebral palsy, sensorineural hearing loss, paralysis of upward gaze, dental enamel dysplasia and death.Recent reports indicate that these conditions, though rare, are still occurring despite the availability of efficient methods for treatment of hyperbilirubinaemia and its prevention.These complications can be prevented if the level of bilirubin is reduced rapidly with exchange blood transfusion.Exchange blood transfusion (EBT) is the most rapid and effective method for lowering serum bilirubin concentrations, but it is rarely needed when intensive phototherapy is effective.In the presence of hemolytic disease, severe anaemia, or a rapid rise in the total serum bilirubin level (greater than 1 mg per dL per hour in less than six hours), EBT is the recommended treatment. EBT also removes partially hemolyzed and antibody-coated erythrocytes and which is then replaced with uncoated donor red blood cells. If intensive phototherapy fails to lower the bilirubin level, then EBT is always considered as the next line of treatment in any newborn with non-hemolytic jaundice.Complications of EBT can include hypocalcaemia, seizures and even death within 24 hours. The potential seriousness of these complications makes clinicians consider intensive phototherapy before EBT.However, the option of intensive phototherapy may not be feasible and could be quite ineffective in resource limited settings where the required facilities and electrical power supply are inadequate. Under these circumstances neonates with severe hyperbilirubinaemia will most likely be treated with EBT.Exchange transfusion of blood collected with acid-citrate-dextrose (ACD) containing bags may produce hypocalcaemia.To decrease the morbidity from chelation of divalent cations by citrate, routine administration of calcium gluconate during EBT was advocated,but tetany, convulsion and death may still occur when ACD blood is used.However, there are controversies about the effectiveness of intravenous calcium in reducing these calcium-related morbidities. A preliminary search for systematic reviews in MEDLINE, the Cochrane Library, Campbell Library and the Joanna Briggs Database of Systematic Reviews and Implementation Reports failed to identify any existing publications on this topic. As a result, this review will examine current quantitative evidence regarding the effectiveness of routine administration of intravenous calcium during EBT in the treatment of severe hyperbilirubinaemia, with specific aim to describe incidences of hypocalcaemia, seizures and deaths after such a transfusion.
Sickle cell disease (SCD) is of serious public health concern. Paucity of literature exists on qualitative experiences of people with SCD, despite substantial research on the clinical signs and management of the disease. This study examined how SCD affects a range of undergraduate students' experiences, their academic achievements, relationships, mental health and healthcare utilization. This was an exploratory qualitative study that interviewed 22 participants selected by thematic saturation between September 2023 and February 2024. The study was conducted in Bowen University, Iwo, Osun State and Bowen University Teaching Hospital, Ogbomoso, Oyo State, annex of Bowen University, Nigeria. Thematic analysis of qualitative data was conducted. Eight distinct themes emerged and were linked to the study objectives. Findings show resilience and determination of the students in navigating the complexities of living with sicknesses while pursuing their academic goals and daily activities. This underscores the need for increased community awareness, support for undergraduates living with SCD, and access to effective healthcare to better assist undergraduates with SCD in managing their health and academic responsibilities effectively. Health professionals and lecturers working with undergraduates with SCD should be aware of diverse coping strategies for them and prioritize integrating such into clinical conversations and support in appropriate contexts.
The burden of Sickle cell anaemia (SCA) is huge in Sub Sahara Africa as it affects 1-2% of the population. HbSS impacts negatively on the quality of life of the sufferers. The clinical manifestations start between 3 and 5 months of life as a result of reduction in foetal hemoglobin.This study describes the clinical and laboratory characteristics of HbSS patients at presentation in steady state, vaso-occlusive and hemolytic crises states.This was a cross sectional, analytical study. Ninety HbSS participants were divided into three groups; steady state, hemolytic and vaso-occlusive crises with 30 individuals in each group. The survey contained sections on bio-data and past medical history obtained from the patients' notes and results of laboratory tests. Data were analysed using SPSS version 23.0. Results were considered statistically significant if p < 0.05.Ninety participants were analysed in this study. The mean age of the participants was 29.4 ± 8.9 years. Only one-third of the participants were diagnosed within the first year of age. Forty-seven (52.2%) participants have steady state haematocrit in the range of 21-25%. All the participants experienced bone pain in a year, about 25% of these participants had more than three episodes of pain per year. There was a statistically significant difference in the mean values of PCV (p < .001), WBC (p < .001), platelet (p = .008), ANC (p < .001), ALC (p < .001), AMC (p < .001), reticulocyte count and ISC % among the different categories.This study established the fact that only a minority of the SCD patients are diagnosed in the first year of life and vaso-occlusive crisis is the most frequent reason for hospital presentation. We therefore recommend the institutionalisation by government policy, neonatal screening programme in Nigeria.KEY MESSAGESThe study highlight delay in early diagnosis of SCA due to unavailability of neonatal diagnosis program in our setting.Bone pain remains the major cause of presentation for SCA and most patients presented after a day of onset of pain to the hospital.
Methods: From August 2003 to August 2007, 98 consecutive, consenting patients, 56 (57%) males and 42 (43%) females, median age 36 years (range, 11-65 years) diagnosed with CML, irrespective of disease phase received Imatinib at a dose of 300-600mg/day at the OAU Teaching Hospitals, Nigeria. Response to therapy was assessed by clinical, haematological and cytogenetic parameters. Blood counts were checked every two weeks in the first three months of therapy. Chromosome analysis was repeated sixth monthly. Overall survival (OS) and frequency of complete or major cytogenetic remission (CCR/MCR) were evaluated.
BACKGROUND: Therapeutic Plasma Exchange (TPE) is an apheresis treatment in which the plasma component of blood is removed and replaced with supplemental fluids. It is an immunomodulatory treatment that has been reported to be a successful therapeutic procedure for the treatment of severely compromised patients with myasthenia gravis when given at short intervals. TPE is known to have a comparable efficacy to intravenous immunoglobulin (IVIG) in the treatments of patients with moderate to severe myasthenia crisis. METHODOLOGY: We report a case of a 47year old male patient with severe myasthenia crisis. He was managed using cobe spectra version 6.1 to carry out an automated TPE, with a suboptimal response and subsequent use of IVIG resulting in full recovery. This report highlights the possible factors that may hinder optimal response of a patient with Myasthenia crisis to TPE procedure in a poor resource setting. CONCLUSION: TPE is an essential immunomodulatory therapy in the management of acute myasthenia crisis whether given alone or in combination with immunosuppressive drugs. There can be a rebound overproduction of the offending autoantibodies in MG following TPE which can be cleared from circulation using immunosuppressive therapy.
Biting is a possible mode of transmission of HIV infection, though the risk of such transmission is believed to be low. Children infected with HIV are at risk of psychological complications as a result of direct or indirect effects associated with the disease. We report the case of an 11 year old HIV positive girl with clinical stage IV disease, who was involved in multiple disputes while on admission on the ward. During one of the disputes she inflicted a deep bite injury on a 10-year old boy, HIV post-exposure prophylaxis (PEP) was commenced 6 hours after the bite and he has remained HIV negative 12 months later. What is peculiar about this case is that the incident occurred in a hospital setting and biting is not usually expected among children of this age. In the era of HIV/AIDS, it is recommended that persons involved in childcare be aware of this potential risk during interactions among children. It is also essential for health care personnel to have sufficient knowledge about PEP in order to reduce the risk of HIV transmission in similar settings. In addition, a multidisciplinary approach to the management of children living with HIV is important in order to identify and address psychosocial factors that may influence symptoms and medical treatment outcome. The risk of transmission of HIV through human bites and the psychosocial impact of the disease on children are also discussed.
Background Problems: With the high demands of sports and the crave for success despite diminishing strength with ageing in the presence of disability, athletes are tempted to contravene the ADRV. Research Objectives: The study aimed to study paralympic athletes’ perspective of doping self-regulatory efficacy in Nigeria. Methods: Descriptive survey design was adopted for the study. A 13-item validated questionnaire (α= .74) was employed to collect data for the study. One-hundred and twenty-four male (81) and female (43) elite para-athletes (mean= 23.15 years, ±3.65) voluntarily participated in the study. ANOVA, PPMC, and Cramer’s V Chi-Square Coefficient Contingency were used to determine the relationship and difference across age, gender and sport type and the extent of the para-athletes’ likelihood to dope and confidence to avoid banned substances, respectively. Findings and Results: It indicated a significant effect of age on likelihood to dope at the p < 0.05 for all conditions (F (1, 123) = 45.84, p = 0.000). Therefore, the null hypothesis was rejected. Findings indicated no significance across gender (0.091, p > 0.05), sport (0.280, p > 0.05), and age (0.263, p > 0.05) on the likelihood to dope. Although, significant among older (0.022), female (0.024) para-athletes. Cramer’s V indicated a strong association when drugs would give immediate fitness (ɸ = 0.217), (ɸ = 0.243), and (ɸ = 0.263) across age, gender, and sport type respectively. Conclusion: It is concluded among others that the para-athletes showed high self-efficacy and low likelihood to dope even in the presence of stressors. However, the ever-pressing need for the athlete’s body longing need for nutrition, oxygen, rest and staying in shape and top form for competing increased the possibility to use a banned drugs for your injury recovery among some older athletes. Psychological interventions are suggested combat the likelihood to dope given the experience levels or psychological dispositions of athletes.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)